MEDICARE: DR LI INTERNAL MEDICINE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1508510884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR LI INTERNAL MEDICINE PA

Provider Business Mailing Address
First Line	:	499 E CENTRAL PKWY STE 205
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3450
Country	:	US
Telephone Number	:	407-960-6709
Fax Number	:	407-960-6727

Provider Business Practice Location Address
First Line	:	499 E CENTRAL PKWY STE 205
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-3450
Country	:	US
Telephone Number	:	407-960-6709
Fax Number	:	407-960-6727

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JIANYU LI
Credential	:	MD
Telephone Number	:	407-960-6709

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	05/20/2022

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Directions to “DR LI INTERNAL MEDICINE PA ” Practice Location

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